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IN THE SPOTLIGHT: Dr. Amir Misaghi

Earlier this year, orthopaedic surgeon Dr. Amir Misaghi joined the CHOC Children’s Orthopaedics Institute. A member of CHOC’s sarcoma team, his special clinical interests range from bone and soft tissue tumors to limb deformities. He shared with us why he decided to become a doctor, new developments in his field, his hobbies outside of work and more.

Dr. Amir Misaghi
Dr. Amirhossein Misaghi, CHOC Children’s orthopaedic surgeon

What is your education and training?

I completed my undergraduate, medical school and orthopaedic surgery residency all at the University of California, San Diego, followed by a pediatric orthopaedic fellowship at Children’s Hospital of Philadelphia and an orthopaedic oncology fellowship at Mayo Clinic in Rochester, Minn.

What are your special clinical interests?

My clinical interests are bone and soft tissue tumors, trauma, hip disorders, limb deformities and other standard pediatric orthopaedic conditions. The vast majority of tumors in kids are benign but can still be complicated. Tumors can be found in difficult-to-operate areas, or be benign but hard to eradicate, so having both a pediatric orthopaedic and an orthopaedic oncology background helps me manage these complexities.

Why did you decide to become a doctor?

I love working with and helping others, and I was drawn to orthopaedics because I’ve always enjoyed using my hands to build and repair things. I also like working in pediatrics because I find kids fun and fascinating to be around. Oftentimes, especially when working with pediatric cancer patients, some very difficult situations and decisions arise, but I feel privileged to partner with families and navigate these challenges alongside them. Kids tend to do remarkably well and have incredible resilience, and I have encountered very powerful moments working in this field. It is an amazing feeling to witness my patients growing up and thriving.

What are some new programs or developments within your specialty?

CHOC is an amazing place with a fantastic pediatric orthopaedic department and cancer center.

Pediatric orthopaedics and pediatric orthopaedic oncology have changed with advances in growing type prosthesis for limb salvage surgery, as well as advances in lengthening limbs and restoring function after major trauma or cancer treatment. We have access to many exciting new pediatric-focused technologies at CHOC.

CHOC also has a great sarcoma team, and it is incredibly rewarding to be part of this multidisciplinary group. We take care of complex patients with the shared goal of providing the best care and getting them back to living happy, healthy lives. I love being able to work closely with Dr. Elyssa Rubin, medical oncologist, and Dr. Raj Vyas, plastic surgeon, to grow our limb salvage and musculoskeletal oncology/sarcoma program. We also have fantastic pediatric interventional radiology with Dr. Tamman Beydoun, and an amazing pathology department with Dr. Aaron Sassoon and Dr. Ali Nael.

What would you most like referring providers to know about you or your division at CHOC?

I want providers to feel confident referring patients to us. We are set up to take care of all benign and malignant bone and soft tissue tumors with a comprehensive team. The oncology program at CHOC is a dedicated group of multidisciplinary providers, including oncology, pediatric surgery, radiation oncology, interventional radiology, radiology and pathology. We meet weekly at our oncology tumor board meeting to discuss complex cases, ensuring we can provide up-to-date, cutting-edge treatment. We are fully equipped as a sarcoma team to manage all malignant bone and soft tissue tumors, and we all focus specifically on pediatrics.

What inspires you most about the care being delivered here at CHOC?

The various providers and patients inspire me. I am constantly impressed by the dedication of the nurses, physicians, child life specialists and countless other staff who work so hard. Taking care of pediatric patients, seeing their strength and witnessing them overcome their challenges is incredible.

If you weren’t a physician, what would you be and why?

I would open a small restaurant – I have always loved cooking, especially outdoors. One of the things I love most about my current job is talking to and getting to know my patients and their families. I think that the restaurant world might offer similar rewarding interactions with people, like chatting with regulars over the years, all while making delicious food.

What are your hobbies and interests outside of work?

I enjoy outdoor activities like camping and fishing, and have recently been trying to interest my kids, ages 3 and 7, in these hobbies as well. We’ve also taken up gardening as a family, and we are always ready for a good barbecue or soccer match.

What have you learned from your patients?

I’ve learned that life is a marathon, not a sprint. It is a joy to watch kids heal after surgery, and to then see them months or years later recovered and back to life. They have also taught me some practical things to keep me plugged in to what is cool and trendy. Recently I was educated about TikTok and some of its popular personalities – one patient suggested I even make a TikTok profile and start showing off some of my dance moves.

Refer a patient to the CHOC Children’s Orthopaedic Institute.

An innovative internship approach during COVID-19

A year ago, Jenae Vancura joined an elite group of college and high school students for a unique and innovative summer internship program at CHOC Children’s. The interns shadowed physicians, joined doctors on their rounds and attended meetings with a wide range of professionals in the medical field.

The days were long. The work was challenging.

And Jenae, a 21-year-old biology major from UC Santa Barbara, is back again this year, now serving as a lead intern for the Sharon Disney Lund Medical Intelligence and Innovation Institute  (MI3) summer internship program. She now helps guide a new group of students through the rigorous program.

“But this year is a little different,” Jenae says.

Now in its eighth year, the internship has been effectively reimagined as a virtual program, a pivot quickly executed at the onset of the global coronavirus pandemic.

The COVID-19 crisis emerged just as CHOC leaders and physicians were gearing up for this year’s internship program. That meant that the 63 participating students would not be able to work directly with hospital staff or go on rounds to interact with patients as in years past.

A look at the virtual model of the Medical Innovation and Intelligence Institute summer internship program.

Cancelling not an option

While many internship programs have been halted worldwide due to COVID-19, canceling the MI3 internship was simply not an option, organizers say. The experience was much too valuable and too many young had worked too hard to get this far.

“Many of our interns look to our program to affirm and motivate their decision to apply to medical school,” says Debra Beauregard, director of MI3. “Nearly all of the interns aspire to become physicians.”

So, with just weeks to go, the decision was made to recalibrate the program and put the whole curriculum online.

“The easy thing would have been to postpone or cancel,” says Dr. Anthony Chang, CHOC’s chief intelligence and innovation officer who launched the program eight years ago. “We wanted to give the students the same level of opportunity. To their credit, the team stepped up and made the internship rotation on par with previous years.”

Dr. Chang started the internship because he wanted to give young people an in-depth experience of the medical field.

“I felt like no one was really doing something like this,” he says. “The students were staying with one mentor doing one assignment. That sounds like a research assignment, not an internship. I wanted to give them access to something that gave them access to a hundred mentors.”

A rigorous pace remains

Even though the pandemic has restricted access to the hospital, it hasn’t slowed the  interns’ pace. Their work schedule starts early and, with a few breaks between, doesn’t end until the evening.

“We set up a lot of Zoom meetings,” Debra says. “Our interns have a full schedule. They participated in rounds and shadowed our physicians virtually. They were even able to remotely view multiple surgeries. This was a challenge, but everyone pulled together to provide what turned out to be a great summer program.”

A small group session during the internship

Dr. Chang says that while the interns are receiving the same level of instruction, what’s missing are some of the personal interactions that come with face-to-face contact.

“Not having one-on-one time in person and not having more intimate moments in small groups is difficult for us,” he says. “For instance, in past years they’ve had one-day retreats where they come to my house for breakfast and lunch. I wasn’t able to do that this year.”

But that doesn’t mean there isn’t room for a little fun.

“Our directors and lead interns made sure that all interns felt connected,” Debra says. “We included team-building exercises, interactive small group sessions, and even a virtual graduation ceremony. The leads even organized a virtual talent show and Zoomie Awards, in addition to a competitive team competition. Our leads have gone above and beyond to ensure that our interns had a meaningful and memorable experience.“

Dr. Sharief Taraman, internship co-director and pediatric neurologist at CHOC, has been part of the program almost since it started. He’s confident that this year’s group is better off than students anywhere else.

“They’re way ahead of their peers in terms of experience and what they can get out of the summer,” he says. “We have a lot of moving parts, so we had to pivot very quickly.”

And to ensure the interns get all the experience they can, they are being invited back next year when they are hopefully able to receive hands-on work.

“We have offered guaranteed spots for our interns next year, so they can have an in-person experience,” Debra says. “We are confident that most will be coming back.”

Student gratitude abounds

The interns themselves are grateful for the chance to continue their internships during these difficult times.

“When I thought it wouldn’t happen, I got very upset,” says 20-year-old Julia Keating from the Massachusetts College of Pharmacy and Health Sciences University. “It’s such a competitive internship.”

For Jessica Octavio, a 20-year old San Diego State student majoring in microbiology, going online was positive experience.

‘’We’re lucky,” she says. “They’ve been more than flexible. The biggest thing was learning this online interface, but as far as programming goes, it’s almost advantageous for us.”

While working on site would have been ideal, Luke Arnold says he appreciates all the work the health system staff have put into making this year’s program a success.

“It’s not ideal and obviously we’d like to have this in person,” says the 21-year-old biology major from Chapman University. “But being in quarantine has given us opportunities to work in group settings. We’re all in this together.”

Interns will be invited back for the 2021 session in hopes of a hands-on experience.

For intern Nicole Fraga, working from home has had some surprising benefits.

“It can be a very rigorous process,” says the 22-year-old recent graduate from Brown University. “But ironically, I think they’re getting closer to the interns online because we are meeting in small groups. We are able to communicate on Slack and share memes. We have a smaller community.”

Dr. Chang calls the internship a “circular experience.” The health system staff, he says, learn as much from the students as the students do from the physicians.

“We’re grateful that the interns are even more inspired to go into medicine despite the pandemic,” he says. “It’s very heartwarming to hear. The future of medicine is in good hands. I see the interns push back against the temptation to give up. They have the idealism and no fear of failure.”

Learn more about the Medical Innovation and Intelligence Institute summer internship program.

CHOC Children’s Launches Telehealth Program to Improve Cardiac Outcomes

CHOC Children’s Hospital has launched an innovative new telehealth program to help improve the short and long-term outcomes of high-risk patients with complex congenital heart defects. 

Parents of patients in the CHOC Children’s Heart Institute’s Cardiac High-Risk Interstage Program are now being issued iPads enabled with Locus Health. This HIPAA-compliant platform monitors vital health data in real-time to be shared with a patient’s care team. The Locus platform is currently used in more than 25 leading children’s hospitals in the U.S. and Canada. CHOC is the first hospital in California to implement the platform.

Patients in CHOC’s Cardiac High-Risk Interstage Program have single ventricle circulation, causing structures on the right or left side of their hearts to be severely underdeveloped. Heart surgery is performed shortly after birth, followed by a second surgery months later. The time between the two interventions is critical due to the baby’s fragile health and risk for life-threatening problems. Monitoring and evaluating a patient’s information on a regular basis has been proven to help with early recognition of possible serious problems and to save lives.

“The goal of our program is to yield the best outcomes for our highest risk heart babies while they recover in the comfort of their own homes,” said Dr. Nita Doshi, a CHOC pediatric cardiologist. “The Locus platform offers our physicians and our patients’ families with an innovative and convenient way to connect and share important information. Our providers have access to data in real-time, providing parents with peace of mind knowing their babies are still under our watchful eyes – even though they are no longer in the hospital.”

Dr. Nita Doshi

The Locus platform is also able to leverage providers’ existing workflows, enabling care teams to more efficiently manage data collected on large groups of patients. This frees up their time to focus even more on direct patient care. Of note, Locus has been proven to reduce the length of a pediatric patient’s hospital stay by more than 30 percent.

“In an era when telehealth has never been more vital, we are thrilled to bring Locus to CHOC Children’s. Our platform was designed by doctors and nurses who saw the need to implement remote patient monitoring into pediatric care and has been proven to benefit patients, parents and healthcare providers alike. We are excited to have our first partner in California be CHOC, which has provided incredible care for children in California for more than 55 years,” said Kirby Farrell, Locus Health CEO.

Study determines that Pain Buddy app may aid in reduction of pain severity

A child, resting in bed, fires up her 7-inch tablet and opens an app.

She selects from a variety of cartoon avatars — such as a panda or penguin — and backgrounds that include a colorful ocean floor with fish and other sea creatures.

Game on.

But this isn’t a typical game. It’s a kid-friendly tool that allows the child, who is being treated for cancer, to report the severity and type of pain she’s experiencing from her home — information her doctor can access in real time.

Playing their way to pain reduction

The app, named Pain Buddy, may aid in the reduction of pain severity in children during cancer treatment, according to results of a pilot study recently published in the online journal Pediatric Blood & Cancer.

The study found that Pain Buddy may be especially beneficial in helping children who have high levels of pain.

Pain Buddy app
Pain Buddy app

Pain Buddy is the brainchild of Michelle A. Fortier, a CHOC Children’s pediatric psychologist who is also a faculty member of the UC Irvine Sue & Bill Gross School of Nursing.

Fortier, who specializes in pain management in children, was principal investigator of the recently published pilot study. that was based on clinical studies of CHOC patients monitored by pediatric oncologist Dr. Lilibeth Torno and pediatric oncology nurse practitioner Christine Yun.

“Pain management is an important part of cancer survivorship, and I think Pain Buddy’s potential for use is very broad,” Dr. Torno says.

Most of the 48 children participating in the eight-week study had been diagnosed with leukemia. All were between the ages of 8 and 18. Results of this particular study come amid ongoing studies on the Pain Buddy app at other sites., Results of the comprehensive research effort, which will track 206 children, are expected in three years, Fortier says.

Pain Buddy app
The Pain Buddy app allows users to identify their pain through various games, like sorting balls into baskets.

The gap in children’s pain management

Pain Buddy, Fortier explained, was developed a few years ago to address a gap in pain management of kids at home compared to kids in the hospital, where it’s easier for doctors and nurses to stay on top of patients’ needs. The 48 children who participated in the pilot study spent a lot of time at home.

Tapping the expertise of professional app developers and researchers at UCI in the California Institute for Telecommunication and Information Technology (Calit2), Fortier and several other colleagues came up with a way for children to rate their pain as they were feeling it from home.

“Most kids experience pretty moderate to severe pain throughout their cancer treatment, and this pain just wasn’t sufficiently being addressed when the patients were at home,” Fortier says. “And when we think about pain assessment, we’re really terrible retrospective reporters of our pain experience.”

But with Pain Buddy, users can say how much they’re hurting, and where, as it’s happening.

“Pain can come from the cancer itself, such as a solid tumor, and it can come from treatment procedures,” Fortier says. “For example, lots of skin-breaking procedures occur during cancer treatment. And treatments like chemotherapy can cause nerve pain, inflammation of the gastrointestinal tract and mouth sores.”

Pain Buddy app
The Pain Buddy app allows users to describe their pain with word bubbles, and can alert the care team.

In addition to completing a pain and symptom diary twice daily, the app automatically alerted the participants’ medical teams about such symptoms as nausea, itching, sadness and redness.

With a touch of a finger, the patients could select word bubbles to indicate descriptions — such as bad, annoying, or and terrible — to describe their pain.

Clinicians, in turn, could promptly address any symptoms that warranted intervention.

Learning skills to cope with pain

A key component of the Pain Buddy app, which for now only has been used by the pilot study participants, is the incorporation of coping skills shown to be effective in the management of pain, such as deep breathing, progressive muscle relaxation and guided imagery.

During these skills training exercises, patients could accumulate coins and, visiting a virtual store, customize their personal avatar and buy additional background themes.

Pain Buddy app
The Pain Buddy app can help patients learn coping skills.

Pain Buddy represents an effective partnership between parents, young cancer patients and the health care institutions that treat them, Dr. Torno says.

“Our focus on cancer survivorship begins on the day of diagnosis,” Torno says.

CHOC’s After Cancer Treatment Survivorship (ACTS) program features a multidisciplinary team of clinical experts who monitor the late effects of cancer and develop a plan for long-term surveillance to ensure the best possible outcomes. Every child at CHOC who has gone through cancer therapy eventually lands in the ACTS program.

Fortier said the ultimate goal is to further refine Pain Buddy and license the app to hospitals for widespread use.

“The goal is to have every kid undergoing cancer treatment — from sarcoma patients to those with bone and other cancers — to have the ability to use Pain Buddy.”

Clinical Trials Continue the Advancement of Pediatric Oncology Treatment

Children, adolescents and young adults with cancers that do not respond to traditional treatments continue to find new treatment options because of CHOC’s extensive efforts and active engagement in clinical trial research.

The Hyundai Cancer Institute at CHOC Children’s is a member of the Children’s Oncology Group (COG) and one of only 21 elite facilities in North America and three in California that has received a prestigious Phase 1 clinical trial designation to offer COG’s investigational, potentially promising and innovative clinical trials. COG is the most experienced organization in the world when it comes to the research and development of new therapeutics for children and adolescents with cancer.

“I’ve witnessed the dramatic progress made in the survival of our pediatric patients because of clinical trials,” says Dr. Ivan Kirov, medical director of oncology and the Hyundai Cancer Institute at CHOC Children’s. “Clinical trials are the mortar behind our successes here at CHOC.”

Dr. Ivan Kirov, medical director of oncology and the Hyundai Cancer Institute at CHOC Children’s
Dr. Ivan Kirov, medical director of oncology and the Hyundai Cancer Institute at CHOC Children’s

CHOC currently offers more than 140 clinical trials in varying phases, including multiple pharmaceutical industry-sponsored clinical trials. Besides membership in COG, CHOC is also a member of the Therapeutic Advances in Childhood Leukemia & Lymphoma consortium (TACL), which offers novel treatments in Phase 1 studies for childhood leukemia and lymphoma; the Lymphoma consortium; and the UC Children, Adolescent and Young Adults Cancer Consortium, which includes all of the University of California pediatric oncology programs.

Among the research at CHOC is an upcoming clinical trial for the treatment of diffuse intrinsic pontine glioma (DIPG), a highly aggressive and one of the most difficult-to-treat childhood tumors.

“We are in the process of opening and initiating this clinical trial which, in my opinion, will be extremely important for patients in the future,” Dr. Kirov says. “DIPG is a brainstem tumor which is universally deadly, and very few patients survive more than a year, or even six months. CHOC, the Dana-Farber Cancer Institute in Boston and Lurie Children’s Hospital in Chicago are the only three sites where this new study will be offered. This study will explore a new vaccine for the treatment of DIPG in combination with checkpoint inhibitors. We’re hoping this study will be open in the next several months to offer hope to patients with this disease.”

While clinical research is fundamental to advancing pediatric oncology treatments, Dr. Kirov said the trials themselves are only part of CHOC’s comprehensive approach to helping children and young adults survive cancer.

“These cutting-edge medications and products we are testing, including new targeting agents, monoclonal antibodies and various types of small molecules and vaccines, for example, require an extremely strong supportive and clinical research infrastructure, which CHOC can offer,” says Dr. Kirov. “Our highly educated clinical research coordinators, physicians-scientists, nurses, educators, pharmacists, and other professionals, along with our unparalleled supportive services for both patients and their families, such as social workers, psychologists, child life specialists, palliative care experts and spiritual services, make our patients’ experiences at CHOC unique, and I think this is why CHOC truly stands out. In fact, many patients who come to CHOC for Phase 1 studies express their desire to stay here even after the study is completed, which really speaks very highly of CHOC and the continuum of care and support we provide to young patients and their families.”

Our Care and Commitment to Children Has Been Recognized

CHOC Children’s Hospital was named one of the nation’s best children’s hospitals by U.S. News & World Report in its 2020-21 Best Children’s Hospitals rankings and ranked in the cancer specialty.

Learn how CHOC’s pediatric oncology treatments, expertise and support programs preserve childhood for children in Orange County, Calif., and beyond.